tbuckley/cabot-search huggingface dataset:
H21 Acne treatments through the ages
Authors: Claire Doyle
Journal: British Journal of Dermatology (2023)

Abstract The search for an effective treatment for acne dates back to 1550 Bc with the Ebers Papyrus, one of the oldest medical documents in the world, mentioning the application of raw honey and sulfur to affected areas. King Tutankhamun is widely believed to have suffered from acne as his tomb was filled with popular acne treatments of the time such as sulfur, sour milk, Aloe vera, myrrh and salt to rid him of his affliction in the afterlife. Much like the Egyptians, ancient Greek texts mention honey and sulfur for the treatment of acne. A Greek physician named Theodosius suggested that patients wipe their spots with a towel while watching a star falling from the sky as he suggested this would result in their spots falling from their faces. The Romans, in addition to the aforementioned honey and sulfur, trialled crocodile meat, cypress oil, sour cheese, leek leaves and cinnamon in their attempts to find a successful treatment. Thomas Bateman wrote in A Practical Synopsis of Cutaneous Disease that a patient reported that bruised parsley cleared her acne. He was also an advocate of remedies used by ancient civilizations. At the turn of the 20th century, American physician W.A. Pusay wrote about the use of ionizing radiation in the treatment of acne. Radiation was widely used in the treatment of acne until the 1960s, when concerns regarding associated secondary carcinogenesis led to the treatment falling out of favour. In the first half of the 20th century, phototherapy was a popular treatment for acne, and quartz mercury vapour lamps, in particular, were used. The most significant advancement in the treatment of acne was the discovery of the utility of synthetic vitamin A. In the 1960s, pharmaceutical company Roche trialled the compound 13-cis-retinoic acid as a treatment for skin cancer. This was ineffective, but it was demonstrated that it was efficacious in the treatment of acne. A study published in 1979 in the New England Journal of Medicine demonstrated that 13 of 14 patients with acne conglobate experienced clearance of their acne. In 1982, the US Food and Drug Administration granted approval for 13-cis-retinoic acid, or isotretinoin, as a treatment for acne. It was introduced in Europe in 1983. Isotretinoin has been a life-changing advance in the treatment of this disease, but its teratogenic effects mean it must be prescribed with education and care.
P105 Adult-onset mastocytosis: a retrospective review
Authors: Siwaporn Hiranput, Kasthuri Nallathamby, Bilal Haider Malik, Lucy Smith, Abigail J Williams, Habibah Ayub, Paul Devakar Yesudian
Journal: British Journal of Dermatology (2023)

Abstract Mastocytosis is characterized by an abnormal proliferation of mast cells in different organs, with the skin being the most frequently affected site. Adult-onset mastocytosis often follows a chronic course and is more likely to have extracutaneous involvement. We undertook a retrospective case note review of adult patients with a diagnosis of mastocytosis in our dermatology department between 2021 and 2022. Fourteen patients were identified with a female-to-male ratio of 1.8 : 1. Median age at disease onset was 46 years (range 25–75). Lesions were described as maculopapular (n = 8), macular (n = 3), telangiectatic (n = 2) and urticated (n = 1). The torso was affected in 12 patients (86%). The most commonly reported symptom was pruritus (n = 9). Other complaints included flushing (n = 3), abdominal pain (n = 2), dizziness (n = 2), weight loss (n = 2), night sweats (n = 2), syncope (n = 1), musculoskeletal pain (n = 1) and symptoms of recurrent anaphylaxis (n = 1). Two patients were asymptomatic. Darier sign was elicited in five patients and negative in two (not documented in seven). Eight patients were assessed for lymphadenopathy and organomegaly, with no detected abnormality. Eleven patients had skin biopsies; 10 (91%) had mastocytosis in the skin confirmed on histology; one patient had a nondiagnostic histological finding, but mastocytosis was diagnosed on the basis of clinical presentation. Seven patients had elevated serum tryptase levels (&amp;gt; 20 ng mL−1) on at least one occasion. Bone densitometry was done in five patients with elevated serum tryptase: two had osteopenia and one had osteoporosis. Eleven patients underwent bone marrow examination. Mast cell infiltration of the bone marrow was detected in four patients; KIT mutations in bone marrow were subsequently identified in three patients. Twelve patients remain under long-term follow-up. Treatments prescribed included antihistamine (n = 10), epinephrine autoinjector (n = 6), topical steroids (n = 5), vitamin D (n = 5), calcium (n = 4), H2 blocker (n = 2), bisphosphonates (n = 2), phototherapy (n = 2), leukotriene antagonists (n = 2), cosmetic camouflage (n = 1), oral sodium cromoglicate (n = 1) and KIT–tyrosine kinase inhibitor (n = 1). Despite treatments, none of the patients had regression (partial or complete) of cutaneous disease, although no fatal outcome was observed. Four (29%) cases had a final diagnosis of indolent systemic mastocytosis (all had elevated serum tryptase levels, two had anaemia). Our findings were consistent with the literature, where serum tryptase levels rather than systemic symptoms were a reliable predictor of systemic mastocytosis. Interestingly, 10 (71%) patients had mastocytosis limited to the skin, which is in contrast to the published literature, where the majority of people with adult-onset mastocytosis have systemic forms of the disease.
PA06 Impact of clinical pharmacist-led isotretinoin management and acne care education at a multispecialty clinic
Authors: Huynh Wynn Tran, Phuong Le
Journal: British Journal of Dermatology (2023)

Abstract Isotretinoin, an oral retinoid derived from vitamin A, is one of the most effective medications in the treatment of severe acne vulgaris. However, it carries serious risks due to the teratogenic nature of the drug. The iPledge national programme in the USA has been founded to reduce and prevent adverse isotretinoin reactions and complications by ensuring its safe use by patients. Owing to the strict monitoring parameters of isotretinoin, an increased workload is placed on prescribing physicians for accurate and timely iPledge authorization, comprehensive counselling, laboratory testing and many patient follow-up visits. The most commonly reported reasons for delay were iPledge-related, including issues navigating the iPledge website, missed pick-up windows, and missed or delayed doctor appointments or laboratory tests. To remedy the difficulties with isotretinoin monitoring, physicians can look to clinical pharmacists as a valuable asset to their practice. Because clinical pharmacists are well trained in isotretinoin dispensing and iPledge regulation and consultation, they can play a crucial role in the management and education of patients with severe acne vulgaris. This retrospective, longitudinal case study takes place at a multispeciality clinic with internal medicine, rheumatology and dermatology. At this multispecialty clinic, a clinical pharmacist will be integrated into the practice with complete patient appointments and isotretinoin follow-ups under the training and direction of a dermatological specialist. The initial evaluation, diagnosis and prescribing of isotretinoin will be completed by the physician. The clinical pharmacist will follow-up the patients in subsequent visits in conjunction with the physician. The study population is approximately 50 patients with existing diagnoses of severe acne vulgaris. The inclusion criteria will include patients with acne who complete a clinical pharmacist visit for isotretinoin acne treatment from September 2022 to March 2023. At each follow-up clinical pharmacist visit, patients receive management and counselling on medications, a review of laboratory values, iPledge verification, and monitoring of symptoms and quality of life. Primary outcomes are patient symptoms and quality of life, acne grade and severity and side-effects; secondary outcomes are navigation of the iPledge website, number of misses in pick-up windows and doctor appointment adherence. The preliminary results showed significant improvement in primary and secondary outcomes. Patient acne grade decreased, while satisfaction increased; there was also a decreased risk of missed pick-up windows and improved doctor appointment adherence compared with the national standard. In addition, a clinical pharmacist-led iPledge programme can substantially reduce the time required for administrative work on managing isotretinoin while maintaining the same quality of care for patients with severe acne.
CD01 Sodium benzoate: an important allergen to patch test to — is 5% in petrolatum too irritant?
Authors: Nicholas Lawrance, Sophie Gaikwad, Catherine Holden
Journal: British Journal of Dermatology (2023)

Abstract Sodium benzoate is a naturally occurring preservative present in substances including cinnamon and apples. It is used as a food preservative and increasingly in leave-on and wash-off personal care products (PCPs), including moisturizers, hand washes, shampoos, mouthwash, toothpaste and baby wipes. Increased use results, in part, from European Union legislation regulating other preservatives, notably methylchloroisothiazolinone and methylisothiazolinone, which are banned in leave-on PCPs and are required to be used in reduced concentrations in wash-off products. Sodium benzoate was recently recommended for consideration for inclusion in the British Society for Cutaneous Allergy facial series after a national audit demonstrated that 1.5% of patients tested positive on patch testing when tested to sodium benzoate 5% in petrolatum (pet.) (Rolls S, Owen E, Bertram CG et al. What is in? What is out? Updating the British Society for Cutaneous Allergy facial series. Br J Dermatol 2021; 184:151–5). In our institution, 3229 patients were patch tested to sodium benzoate 5% in pet. from Chemotechnique Diagnostics™ from 2008 to 2022. It was tested in targeted series, bakery and cheilitis (2008–2022), and variably in fragrance (2012–2018) and cosmetic (2015–2018 and 2021–2022) series. We noted many irritant reactions to sodium benzoate 5% pet. and undertook an audit. Fifty-seven (1.8%) patients had positive reactions (+/++), 52 (1.6%) had doubtful reactions (? +), and 133 (4.1%) had irritant reactions. Of the positive reactions, 38 (66.7%) were of current relevance and 19 (33.3%) were of unknown relevance. The frequency of positive (+/++) reactions in the different targeted series was as follows: bakery and cheilitis 1.5%, cosmetic 1.7% and fragrance 2.1%. Concerningly, over three times more patients had irritant or doubtful reactions (5.7%) than those who tested positive (1.8%). When concentrations of a patch test preparation are decreased, the rate of irritancy on patch testing usually also decreases (Johansen J, Aalto-Korte K, Agner T et al. European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice. Contact Dermatitis 2015; 73:195–221). Given that sodium benzoate is a known allergen with increasing frequency of use, it is important that the optimum concentration and vehicle are used for patch testing to ensure adequate sensitivity but low irritancy. Decreasing the patch test concentration of sodium benzoate to 2% in pet., which is commercially available, may reduce irritant reactions and the risk of false positives. We recommend that dilutional studies should be performed comparing 5% with 2% in pet. with the hope that the latter is comparatively a nonirritant preparation without loss of sensitivity.
P93 Dupilumab treatment in children with moderate-to-severe atopic dermatitis increases levels of bone mineralization biomarkers
Authors: Alan D Irvine, Amy S Paller, Julie E Horowitz, Annamaria Farrell, Sarah Hatsell, Peter Ehmann, Robert McDonald, Ainara Rodriguez Marco, Tingting Tian, Sonya L Cyr
Journal: British Journal of Dermatology (2023)

Abstract Children with atopic dermatitis (AD) are at risk for lower bone mineral density (BMD) and lower alkaline phosphatase (ALP) levels than healthy children. Low BMD and ALP in children could contribute to a higher lifetime prevalence of fractures, osteopenia and osteoporosis. Dupilumab is a fully humanized monoclonal anti-interleukin (IL)-4R antibody approved for the treatment of AD in children. The objective of this analysis is to report the impact of dupilumab treatment on markers of bone mineralization in children aged 6–12 years with moderate-to-severe AD vs. reference intervals (RIs). Analysis was performed retrospectively on sera from participants in LIBERTY AD PEDS, a phase III placebo-controlled trial of 16 weeks (NCT03345914) and LIBERTY AD PED-OLE (NCT02612454), an open-label extension trial in which eligible patients received dupilumab until week 52. Biomarkers, including bone ALP (BALP), procollagen type 1 N-terminal propeptide (P1NP), C-terminal crosslinking telopeptide of β-1 collagen (β-CTX), osteocalcin (OC) and insulin-like growth factor 1 (IGF-1), were analysed at baseline, 8, 12 and 16 weeks; only BALP was measured at 52 weeks. Both dupilumab dosing regimens led to significant increases in geometric mean (SE) levels of BALP at 8, 12 and 16 weeks compared with placebo. For the 100/200-mg Q2W group, at week 8 the BALP level was 72.7 (1.03) μg L−1 vs. 62.0 (1.05) μg L−1 (P &amp;lt; 0.0001), at week 12 it was 74.7 (1.03) μg L−1 vs. 64.3 (1.05) μg L−1 (P &amp;lt; 0.001) and at week 16 it was 78.0 (1.03) μg L−1 vs. 65.0 (1.04) μg L−1 (P &amp;lt; 0.001). For the 300-mg Q4W group, at week 8 the BALP level was 76.7 (1.03) μg L−1 vs. 62.0 (1.05) μg L−1 (P &amp;lt; 0.001), at week 12 it was 73.3 (1.04) μg L−1 vs. 64.3 (1.05) μg L−1 (P = 0.002) and at week 16 it was 77.3 (1.03) μg L−1 vs. 65.0 (1.04) μg L−1 (P &amp;lt; 0.001). At 52 weeks, BALP levels were statistically significantly increased compared with baseline [placebo vs. placebo transitioned to dupilumab: 64.2 (1.04) μg L−1 vs. 82.9 (1.04) μg L−1 (P &amp;lt; 0.001); 100/200 mg Q2W: 62.0 (1.05) μg L−1 vs. 83.8 (1.03) μg L−1 (P &amp;lt; 0.001); 300 mg Q4W: 64.1 (1.04) μg L−1 vs. 78.7 (1.04) μg L−1 (P &amp;lt; 0.001)] and also increased within RIs. From baseline to week 16, OC, P1NP and β-CTX levels improved from below to within the RIs, and levels of IGF-1 increased from the lower limit of the RI. However, data points were limited due to insufficient sera volumes, preventing statistical analyses for these biomarkers. The overall results suggest an increase in bone mineralization biomarkers in paediatric patients with moderate-to-severe AD following dupilumab treatment. Funding sources:research sponsored by Sanofi and Regeneron Pharmaceuticals Inc.
BH09 Patient experience of off-label Janus kinase inhibitor use for alopecia areata in a cohort of 34 patients from a single UK practitioner: exploring changing trends in healthcare provision and access to drug treatments
Authors: Sarah Ryan, Anna Ascott, Paul Farrant
Journal: British Journal of Dermatology (2023)

Abstract We present data from a UK cohort of patients with alopecia areata (AA) who have sought Janus kinase inhibitor (JAKi) treatments prior to National Health Service funding. We have explored referral methods, access to consultations, and shared care in monitoring and acquisition of medication both from the UK and abroad. We have looked at the drugs and dosage, adjuvant therapies and response to treatment, and report data on side-effects and reasons for changing drugs or stopping treatment. Thirty-four patients (25 adults and nine children) self-referred to a UK-based private hair clinic for JAKi treatment over a period of 36 months. The median age of patients was 40 years (interquartile range 18–50). The patients sought treatment from a wide geographical area in the UK, with one patient living 400 miles from the clinic. Seventeen (50%) and 14 (41%) patients were prescribed baricitinib and tofacitanib, respectively, with three (9%) patients prescribed both. Nineteen (56%) patients had severe alopecia with &amp;gt; 95% hair loss. Social media, in particular a closed Facebook group, was an important source of referral and information on sourcing medication from abroad. Nine per cent of consultations were virtual (telephone/video). The cost of treatment varied from £100 per month to £1400, with a large difference between UK-sourced medication and that from abroad. Eight (24%) patients showed no scalp regrowth response to first-line treatment, despite dose escalation, with one subsequently experiencing total hair regrowth on swapping to a different JAKi class. One patient had to stop treatment after developing breast cancer. JAKi are an exciting and emerging treatment for AA that are yet to be widely prescribed by UK practitioners. However, the response to JAKi is not universal. Owing to the cost of private prescription, patients are choosing to source JAKi from abroad. Our study presents data on how the alopecia community has helped inform patients about treatment access.
PD07 Sun exposure and associated risks in 17 countries: UK results
Authors: Thierry Passeron, Brigitte Dreno, Susana Puig, Chee L Goh, Henri W Lim, Fatimata Ly, Hee Y Kang, Akimichi Morita, Jorge Ocampo Candiani, Sergio Schalka, Liu Wei, Caroline Le Floc’h, Delphine Kerob, Jean Krutmann
Journal: British Journal of Dermatology (2023)

Abstract Primary and secondary prevention of skin cancer varies considerably from one country to another. This survey investigates knowledge and behaviours regarding sun exposure in the UK. This UK survey (n = 1000) was conducted online from 28 September to 18 October 2021 and was part of a worldwide survey (n = 17 001) conducted in 17 countries (five continents). Automated selection from the Ipsos online panel ensured samples of 1000 individuals in each country fit the quotas method based on sex, age, employment status and country regions. Data covered demographics, phototype, exposure habits and practices, and knowledge and understanding of risks. The population comprised 49% men [mean (SD) age 46.6 (15.7) years]; 61% were of skin phototypes I–II. Seventy-six per cent of Britons stated that a tanned skin looks attractive vs. 72% worldwide. Seventy per cent of Britons indicated that a tan gives a healthy look, a different perception compared with worldwide (64%). Most Britons were aware of sun-related skin health issues, a better awareness compared with worldwide (94% vs. 88%). Sixty-one per cent did know that sun protection is useful when the weather is overcast, a similar knowledge as worldwide (61%). Furthermore, 15% indicated it was safe to expose themselves without protection when already tanned, a better knowledge than worldwide (23%). In terms of photoprotection, 15% said they protected themselves from the sun all year round, a lower score compared with worldwide (23%). In detail, Britons were more likely to put sunscreen on their face (71% vs. 60%), on their hands, neck and ears (64% vs. 52%), and on the arms, legs and chest (69% vs. 55%) compared with the global population. However, Britons were less likely to try to stay in the shade (73% vs. 77% worldwide) or avoid midday sun exposure (53% vs. 66%). Of those who applied sunscreen, 69% applied it only once or twice a day – a slightly better practice compared with the worldwide average (74%). In terms of knowledge, 71% did not understand the difference between ultraviolet (UV)A and UVB vs. 70% worldwide. Although the risks of sun exposure are widely recognized, sun protection practice is inadequate. This survey provides insight into the need for additional photoprotection education in the UK.
H16 Arsenic to biologics: psoriasis treatment through the ages
Authors: Rabia Sarfraz
Journal: British Journal of Dermatology (2023)

Abstract In the 19th century when arsenic was the recommended treatment for psoriasis, little consideration was given to the toxic side-effects of the potent carcinogen. Thomas Girdlestone, an English physician, is said to have been the first to advocate for the use of arsenic to treat psoriasis. Girdlestone prescribed Fowler’s solution, a solution of potassium arsenite 1%. In 1876, Alexander John Balmanno Squire inadvertently discovered dithranol, a known treatment for ringworm, to be efficacious in treating psoriasis. However, it was Eugen Galewsky, in 1916, who then went on to synthesize anthralin, a synthetic form of dithranol, to target psoriasis. A key historical figure was William H. Geockerman, an American dermatologist, who developed Goekerman therapy—a regimen that combined the use of coal tar and ultraviolet (UV) light to treat moderate-to-severe plaque psoriasis. In 1953, John Ingram, an English dermatologist, discovered that the beneficial effects of dithranol paste could be enhanced by adding it to coal tar and UV light—later coined the ‘Ingram regimen’. Philip Showalter Hench, Edward Calvin Kendall and Tadeus Reichstein received the Nobel Prize in Medicine and Physiology for the development of cortisone; it proved to be useful in topically treating many skin diseases, but it had a limited effect on psoriasis. The production of synthetic corticosteroids soon followed, which, conversely, proved to be successful in treating psoriasis. However, the daunting side-effects of corticosteroids limited their long-term use. In 1951, a patient with rheumatoid arthritis showed dramatic improvement in their psoriasis when treated with aminopterin, as recorded by Richard Gubner, a New York cardiologist. PUVA was developed in the 1970s—a photochemotherapy for psoriasis that combined psoralen with UVA radiation to clear skin lesions. Interestingly, in 1500 Bc, the ancient Egyptians were known to use a combination of psoralen and sunlight to treat vitiligo. Furthermore, in the 1980s, researchers noted complete clearance of psoriasis in a patient with osteoporosis who was prescribed an oral form of vitamin D. This chance observation then led to the development of topical vitamin D analogues for the treatment of psoriasis that work by encouraging normal skin growth and slowing down overproduction of skin cells. Finally, in 2003, the first biologic treatments were approved for psoriasis by the US Food and Drug Administration—a significantly safer and more efficacious alternative to the controversial arsenic treatments that were used over 200 years ago.